Published on May 20, 2020
On May 4, the Department of Labor, Treasury Department and Internal Revenue Service issued joint rulings that extend various deadlines during the COVID-19 state of emergency.
According to the DOL, EBSA Disaster Relief Notice 2020-01, "extends certain time frames affecting participants’ rights to healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and extends the time for plan participants to file or perfect benefit claims or appeals of denied claims. These extensions provide participants and beneficiaries of employee benefit plans additional time to make important health coverage and other decisions affecting their benefits during the coronavirus outbreak."
There are two guidances that may affect your employer sponsored Difference Card plan:
1. Claim Run Out
Normally, participants have until the end of the claim run out period to submit claims for the prior year. Under the new guidance, any claim run out ending AFTER February 29, 2020 has been extended to 60 days after the declaration of the national emergency.
For example: Employee A has a plan that ended on November 30, which means the claim run out ended on February 29, 2020. Under the new guidance, there is no change to Employee A's claim run out period. However, if Employee A was enrolled in a plan ending on December 31 and the claim run out for 2019 expenses normally ended on March 31, 2020, then that deadline how now been extended for an additional 60 days after the end of the national emergency is declared.
Normally, participants have 180 days to submit an appeal upon receiving notice of an adverse benefit decision when they receive a claim denial letter. That timeframe is now extended to 60 days until after the end of the national emergency.
For example: Employee B received a claim denial letter on October 1, 2019. Under ERISA, Employee B would normally have 180 days or until March 28, 2020 to submit an appeal. That deadline is now extended through 60 days until after the end of the federal emergency.
COVID-19 FAQs for Participants and Beneficiaries
U.S. DEPARTMENT OF LABOR ISSUES COVID-19 RELIEF AND GUIDANCE FOR EMPLOYEE BENEFIT PLANS
Extension of Certain Timeframes for Employee Benefit Plans, Participants, and Beneficiaries Affected by the COVID-19 Outbreak